PATIENT CHARACTERISTICS ASSOCIATED WITH FAILURE OF TUBERCULOSIS PREVENTION

Objectives: The cost-effectiveness of tuberculin screening may be subs tantially reduced by noncompliance of patients and physicians. We have examined the association of these problems with the sociodemographic characteristics of tuberculin reactors. Methods: Community-based tuber culin screening was conducted among students in grades 6 and 10, and i n post-secondary health training, as well as young adult workers. A fo llow-up survey was conducted to determine if tuberculin reactors refer red for further evaluation actually reported, if they were prescribed therapy when indicated, and if they took therapy when it was prescribe d. Association of reactors' socio-demographic characteristics with the se outcomes was analyzed. Results: Canadian-born subjects were less li kely to report if they were: older (adjusted and standardized odds rat io: 0.7, 95% confidence interval: [0.5, 0.9]), resident in more afflue nt neighbourhoods (0.7 [0.5, 0.99]), and from single parent households (0.1 [0, 0.9]). Even when indicated, physicians were less likely to p rescribe treatment for Canadian-born subjects who reported bacille Cal mette-Guerin vaccination, but had not actually received this (0.3 [0.1 , 0.7]), or who were from single-parent households (0.1 [0, 0.9]). Phy sicians mere less likely to prescribe treatment for foreign-born who g ave a history of BCG vaccination (0.1 [0.1, 0.3]), and were more likel y to prescribe treatment for reactors from countries such as Haiti or Vietnam. The only factor significantly associated with compliance was that older Canadian-born subjects were less compliant (0.6 [0.4, 0.97] ). Conclusions: Failure to report for further medical evaluation and p hysician non-compliance were associated with a number of socio-demogra phic characteristics, and substantially reduced the benefit of a tuber culosis screening program.